These Physicians Explain Why They'd Never Go Back to Being Employed

Independence in medicine looks different depending on who you ask. For one physician it's a shared savings check that finally rewards prevention over volume. For another it's a thirty-year pediatric practice fighting to survive on razor-thin margins. For others it's a direct primary care model built on trust, a referral network trying to fix isolation, or 170 equal partners standing between a practice and private equity. Here are the sharpest moments from five physicians who left employed medicine behind.

Farzad Mostashari Explains Why Independent Primary Care Doctors Are the Most Powerful People in Healthcare

"Physicians are cogs in that big machine when you're part of an employed system. You've got to ask yourself: what are the machine's goals?"

Farzad Mostashari, the former National Coordinator for Health IT and now CEO of Aledade, makes the economic case for independent primary care: when payment shifts from fee-for-service to shared savings, the power structure in healthcare inverts, and independent physicians become the ones best positioned to benefit. He also gets personal about what it means to be, in his words, "a cog in a machine" you didn't design and don't control. His segment closes on a story about his own father being turned away from a primary care office and told to call a 1-800 number, the kind of moment he says would never happen at an independent practice.

Full episode: The Future of Primary Care Is Independence, And It's More Lucrative Than You Think

Connect with Farzad: LinkedIn

Ari Brown Says Independent Pediatrics Is on the Extinction List

"I feel like I am on the extinction list of some sort. Pediatricians are at risk of extinction. The margins are so small."

Dr. Ari Brown has run her independent practice, 411 Pediatrics, in Austin for more than thirty years, and built a parallel career as the bestselling author of the Baby 411 book series. In her segment, she's remarkably candid about the fragility underneath that longevity: razor-thin margins, a business model under real strain, and a blunt admission that she feels like she's "on the extinction list" as a pediatrician in independent practice. It's a needed counterweight to the optimism elsewhere in the episode, a reminder that independence surviving thirty years doesn't mean it's safe.

Full episode: Dr. Ari Brown on What Happened to Trust Between Parents and Pediatricians

Connect with Ari: LinkedIn

Paulius Mui Built a Practice Where Patients Pay What They Can Afford

"It's not the best financial decision for me, but it's what fills my cup, and it's reignited the passion for why people went into medicine in the first place."

Dr. Paulius Mui, a family medicine physician and founder of XPC Health, walked away from full-time employed primary care to build something almost nobody else is trying: a direct primary care practice where patients pay whatever they can. He's upfront that it isn't the best financial decision he could have made, but frames it as a kind of self-imposed tithe that restored the reason he went into medicine in the first place. His segment captures a different flavor of independence than the rest of the episode, mission-driven rather than economically driven.

Full episode: How Dr. Paulius Mui Is Reinventing Primary Care to Put Patients First

Connect with Paulius: LinkedIn

Basil Kahwash on Why Independent Doesn't Have to Mean Isolated

"Independent to some extent means isolated. You're in private practice, you have this referral black hole."

Dr. Basil Kahwash, an allergist and immunologist who co-authored Offcall's Referral Manifesto with Graham, names the part of independent practice that rarely gets discussed honestly: the isolation. After leaving an academic position at Vanderbilt, he describes losing the built-in network of colleagues that made complex cases manageable, and replacing it with not much more than a fax machine. His segment turns that honest diagnosis into a vision, a connected network of independent physicians that restores collaboration without giving up autonomy.

Full episode: Going Independent Doesn't Mean Going It Alone

Connect with Basil: LinkedIn

Bradley Block on the ENT Practice Too Big for Private Equity to Buy

"It's the clear path to full equity partnership. We are partners."

Dr. Bradley Block is an otolaryngologist and elected board member at ENT and Allergy Associates, the largest independent ENT, allergy, and audiology practice in the country. His segment lays out exactly why ENTA has stayed independent while private equity buys up practices across his specialty: a contract every incoming physician can read on day one, guaranteeing a clear, no-buy-in path to full equity partnership. With roughly 170 equal partners at every career stage, Brad argues that scale, not resistance, is what actually keeps a buyer away, since unifying that many owners around a single deal is nearly impossible.

Full episode: The Physician-Owned Practice That Private Equity Can't Buy With Dr. Bradley Block

Connect with Brad: LinkedIn

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